MRI BI-RADS 4类乳腺病变亚分类的临床应用研究OA
Clinical application of subcategorization of MRI BI-RADS category 4 breast lesions
目的 探讨MRI乳腺影像报告与数据系统(BI-RADS)4类病变进一步分为4A、4B、4C的可行性及临床应用价值,并与超声(US)、乳腺X线摄影(MG)比较诊断效能.方法 回顾性纳入乳腺病变病人220例,均完成US、MG及乳腺MRI检查且经手术或穿刺获得病理结果,共225个病灶分类为MRI BI-RADS4类.根据乳腺影像学会(SBI)和北美放射学会(RSNA)的系列报告进一步对病变进行MRI BI-RADS 4A、4B、4C亚分类.以病理结果为金标准,计算各亚分类的恶性率并进行比较.采用受试者操作特征(ROC)曲线评估US BI-RADS、MG BI-RADS和MRI BI-RADS分类对乳腺病变的诊断效能,计算其曲线下面积(AUC)、准确度、敏感度、特异度.采用Delong检验比较AUC值的差异.结果 MRI BI-RADS 4A、4B、4C类病灶分别为42、53、130个,其中病理诊断为恶性的病灶分别有5、41、127个,各亚分类相应的恶性率分别为11.9%、77.4%、97.7%,亚分类间两两比较差异均有统计学意义(P<0.016),4A类恶性率最低,4C类恶性率最高.MRI BI-RADS对良恶性诊断的准确度、敏感度最高(91.11%和97.11%),MG BI-RADS分类的特异度最高(86.54%).MRI BI-RADS、US BI-RADS、MG BI-RADS的AUC值为0.910(95%CI:0.867～0.953)、0.871(95%CI:0.824～0.917)和 0.806(95%CI:0.748～0.863),MRI BI-RADS 分类的效能高于MG BI-RADS分类(Z=3.407,P=0.001),而与US BI-RADS效能相仿(Z=1.402,P=0.161).结论 MRI BI-RADS4类进行亚分类具有可行性及重要的临床应用价值,能够为BI-RADS 4类乳腺病变的良恶性鉴别提供相关诊断依据.
Objective To investigate the feasibility and clinical application value of further subclassifying MRI Breast Imaging Reporting and Data System(BI-RADS)category 4 lesions into 4A,4B,and 4C,and to compare its diagnostic performance with ultrasound(US)and mammography(MG).Methods A total of 220 patients with breast lesions were retrospectively included.All patients underwent US,MG,and breast MRI examinations and obtained pathological results by surgery or biopsy.A total of 225 lesions were classified as MRI BI-RADS category 4.According to a series of reports from the Society of Breast Imaging(SBI)and the Radiological Society of North America(RSNA),the lesions were further subclassified into MRI BI-RADS 4A,4B,and 4C.Using pathological results as the gold standard,the malignancy rates of each subcategory were calculated and compared.Receiver operating characteristic(ROC)curve analysis was used to evaluate the diagnostic performance of US BI-RADS,MG BI-RADS,and MRI BI-RADS classifications for breast lesions,and the area under the curve(AUC),accuracy,sensitivity,and specificity were calculated.Differences in AUC values were compared using the DeLong test.Results There were 42,53,and 130 lesions classified as MRI BI-RADS 4A,4B,and 4C,respectively,among which 5,41,and 127 lesions were pathologically diagnosed as malignant.The corresponding malignancy rates were 11.9%,77.4%,and 97.7%,respectively.Pairwise comparisons among the subcategories showed statistically significant differences(P<0.016).The malignancy rate was lowest in category 4A and highest in category 4C.MRI BI-RADS classification had the highest accuracy and sensitivity for differentiating benign from malignant lesions(91.11%and 97.11%,respectively),whereas MG BI-RADS classification had the highest specificity(86.54%).The AUC values of MRI BI-RADS,US BI-RADS,and MG BI-RADS were 0.910(95%CI:0.867-0.953),0.871(95%CI:0.824-0.917),and 0.806(95%CI:0.748-0.863),respectively.MRI BI-RADSshowed higher diagnostic performance than MG BI-RADS(Z=3.407,P=0.001),while its performance was comparable to that ofUS BI-RADS(Z=1.402,P=0.161).Conclusion Subcategorization of MRI BI-RADS category 4 lesions is feasible and has important clinical application value.It can provide useful diagnostic evidence for differentiating benign from malignant breast lesions classified as BI-RADS category 4.
李慧瑶;张宁;秦永照;吴兰英;岳云龙
首都医科大学附属北京世纪坛医院,医学影像科 超声科,北京 100038首都医科大学附属北京世纪坛医院,医学影像科 超声科,北京 100038首都医科大学附属北京世纪坛医院,医学影像科 超声科,北京 100038首都医科大学附属北京世纪坛医院,医学影像科,北京 100038首都医科大学附属北京世纪坛医院,医学影像科 超声科,北京 100038
医药卫生
磁共振成像乳腺病变乳腺影像报告与数据系统分类亚分类
Magnetic resonance imagingBreast lesionBreast imaging reporting and data system categorySubcategorization
《国际医学放射学杂志》 2026 (3)
281-287,7
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